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Anti-Acanthamoeba Synergistic Effect of Chlorhexidine and Garcinia

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Anti-Acanthamoeba Synergistic Effect of Chlorhexidine and Garcinia www.nature.com/scientificreports OPEN Anti‑Acanthamoeba synergistic efect of chlorhexidine and Garcinia mangostana extract or α‑mangostin against Acanthamoeba triangularis trophozoite and cyst forms Suthinee Sangkanu1, Watcharapong Mitsuwan1,2, Wilawan Mahabusarakam3, Tajudeen O. Jimoh4,5, Polrat Wilairatana6*, Ana Paula Girol7, Ajoy K. Verma8, Maria de Lourdes Pereira9, Mohammed Rahmatullah10, Christophe Wiart11, Abolghasem Siyadatpanah12, Roghayeh Norouzi13, Polydor Ngoy Mutombo14,15 & Veeranoot Nissapatorn1* Acanthamoeba spp. can cause amoebic keratitis (AK). Chlorhexidine is efective for AK treatment as monotherapy, but with a relative failure on drug bioavailability in the deep corneal stroma. The combination of chlorhexidine and propamidine isethionate is recommended in the current AK treatment. However, the efectiveness of treatment depends on the parasite and virulence strains. This study aims to determine the potential of Garcinia mangostana pericarp extract and α‑mangostin against Acanthamoeba triangularis, as well as the combination with chlorhexidine in the treatment of Acanthamoeba infection. The minimal inhibitory concentrations (MICs) of the extract and α‑mangostin were assessed in trophozoites with 0.25 and 0.5 mg/mL, for cysts with 4 and 1 mg/mL, respectively. The MIC of the extract and α‑mangostin inhibited the growth of A. triangularis trophozoites and cysts for up to 72 h. The extract and α‑mangostin combined with chlorhexidine demonstrated good synergism, resulting in a reduction of 1/4–1/16 of the MIC. The SEM results showed that Acanthamoeba cells treated with a single drug and its combination caused damage to the cell membrane and irregular cell shapes. A good combination displayed by the extract or α‑mangostin and chlorhexidine, described for the frst time. Therefore, this approach is promising as an alternative method for the management of Acanthamoeba infection in the future. 1School of Allied Health Sciences, Southeast Asia Water Team (SEA Water Team), World Union for Herbal Drug Discovery (WUHeDD), and Research Excellence Center for Innovation and Health Products (RECIHP), Walailak University, Nakhon Si Thammarat, Thailand. 2Akkhraratchakumari Veterinary College and Research Center of Excellence in Innovation of Essential Oil, Walailak University, Nakhon Si Thammarat, Thailand. 3Division of Physical Science, Faculty of Science, Prince of Songkla University, Songkhla, Thailand. 4Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand. 5Department of Biochemistry, Habib Medical School, Islamic University in Uganda, Kampala, Uganda. 6Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. 7Department of Biology, Faculty of Sciences, São Paulo State University, São Paulo, Brazil. 8Department of Microbiology, National Institute of Tuberculosis & Respiratory Diseases (NITRD), New Delhi, India. 9Department of Medical Sciences, CICECO-Aveiro Institute of Materials &, University of Aveiro, Aveiro, Portugal. 10Department of Biotechnology & Genetic Engineering, University of Development Alternative Lalmatia, Dhaka, Bangladesh. 11School of Pharmacy, University of Nottingham Malaysia Campus, Selangor, Malaysia. 12Ferdows School of Paramedical and Health, Birjand University of Medical Sciences, Birjand, Iran. 13Department of Pathobiology, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran. 14School of Public Health and Community Medicine, UNSW Medicine, UNSW, Sydney, NSW, Australia. 15Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia. *email: [email protected]; [email protected] Scientifc Reports | (2021) 11:8053 | https://doi.org/10.1038/s41598-021-87381-x 1 Vol.:(0123456789) www.nature.com/scientificreports/ Figure 1. Primary sequence alignment of the DF3 region using CLUSTAL W. Te region shown a subset of the total DF3 region which demonstrates the highest variation. Asterisks denote similarities and dashes denote gaps within the nucleotide sequences. Acanthamoeba is an opportunistic amoeba distributed in diverse natural habitats 1. Tis organism have two main forms: the trophozoite, an invasive stage; and cyst, a highly resistant stage in a very harsh conditions 2. Based on the size, shape and features of cysts, Acanthamoeba spp. have been divided into three groups (I, II, III). However, Acanthamoeba spp. has been classifed into 22 diferent genotypes (T1–T22 Genotype) based on molecular technique, which used 18S rRNA gene sequencing 3–5. Among them, T4 genotyge is the most isolated in clinical and environmental samples, followed by genotypes T3 and T5. In addition, the T4 genotype is the most virulent because it has a signifcant potential for binding to host cells than other genotypes 6. Acanthamoeba spp. are the causative agents of amoebic keratitis (AK) and granulomatous amoebic encephali- tis (GAE). AK can cause permanent loss of vision 7. Te rate of infectious keratitis is becoming alarming in recent times, a problem that may be related to a sudden increase in the population of contact lens wearers 2 Similarly, Acanthamoeba encysts penetrated deeply into the corneal stroma 8 as such, the cyst wall becomes impervious to existing drugs, and this becomes a drawback for further studies in the areas of drug formulations and designed for this organism. Garcinia mangostana Linn. is generally known as mangosteen and belongs to the family Clusiaceae. It is a tropical tree, widely distributed in Southeast Asia9. Te pericarps of this fruit are commonly used in traditional medicine to treat several diseases which are non-toxic and safe to use10,11. Major compound in the mango- steen pericarps is xanthone group, particularly α-mangostin, which exhibited antibacterial activity 12, antifungal activity13, antioxidant activity 14 anti-cancer activity 15–17, anti-infammatory activity 18,19, antiparasitic activity20–22. To the best of our knowledge, we discover that there is no single report on the anti-Acanthamoeba activity of G. mangostana extract to date. Hence, our study sought to investigate the efective concentration of the G. mangostana extract and α-mangostin on the growth inhibition of Acanthamoeba spp. and to demonstrate its synergistic efects combined with chlorhexidine on anti-Acanthamoeba activity. Results Genotypic and species identifcation of Acanthamoeba isolate WU19001. Te partial nucleotide sequences of DF3 region of Acanthamoeba sp. WU19001 from our previous study aligned using CLUSTAL W and revealed the highest variation, as shown in Fig. 1. Te 18S rDNA sequences were subjected to phylogenetic analysis and species identifcation. It showed very similar patterns to Acanthamoeba triangularis KX232518.1 (99.74% similarity). Te sequence homology search for the 35 Acanthamoeba spp. in the National Center for Biotechnology Information (NCBI) database showed WU19001 formed Acanthamoeba genotype T4 cluster (Fig. 2). Te nucleotide sequence of WU19001 has been deposited at Genbank under the accession number MW647650. Minimum inhibitory concentration (MIC). G. mangostana extract and α-mangostin were determined for their anti-Acanthamoeba potential by MIC using the microtiter dilution broth method. As shown in Table 1, the MICs of G. mangostana extract against A. triangularis trophozoites and cysts were 0.25 and 4 mg/mL. Te pure compound, α-mangostin, exhibited MIC values at 0.5 and 1 mg/mL for trophozoites and cysts. Te MIC values of chlorhexidine against trophozoites and cysts were 0.008 and 0.064 mg/mL, respectively. Growth assay. Susceptibilities of A. triangularis to G. mangostana extract and α-mangostin were deter- mined by growth assay. A. triangularis was found to be signifcantly (p < 0.05) susceptible to the extract and α-mangostin at all concentrations when compared to control. Te extract and α-mangostin showed higher sus- ceptibility against Acanthamoeba trophozoites than cysts. (Fig. 3). Afer 72 h incubation, MIC values of the extract and α-mangostin could decrease the viability to 0.15 × ­105 and 0.1 × 10 5 cells/mL of trophozoites as com- pared to the control (6.0 × ­105) (Fig. 3a,b). Afer 24 h of incubation, the number of Acanthamoeba cysts decreased to 2.3 × ­105 and 0.8 × 105 cells/mL when treated with MIC concentration of the extract and α-mangostin, respectively. We observed the re-growth which reached to the number of viable cells of 1.4 × ­105 and 2.2 × ­105 cells/mL in the presence of the extract and α-mangostin at 72 h of incubation. However, the treated cysts showed a decrease in viable cells when compared with the control that reached up to 5.8 × ­105 cells/mL at 72 h of incubation (Fig. 3c,d). Scientifc Reports | (2021) 11:8053 | https://doi.org/10.1038/s41598-021-87381-x 2 Vol:.(1234567890) www.nature.com/scientificreports/ Figure 2. A phylogenetic tree was constructed using the neighbour-joining method with the Kimura two- parameter algorithm with bootstrapping values for 1000 replicates. Te tree was reconstructed by considering 35 Acanthamoeba spp. isolates with the reference strains from NCBI. MIC (mg/mL) Antimicrobial agents Trophozoites Cysts G. mangostana extract 0.25 4 α-mangostin 0.5 1 Chlorhexidine 0.008 0.064 Table 1. Minimal inhibitory concentration (MIC) of G. mangostana extract, α-mangostin and chlorhexidine against A. triangularis trophozoites and cysts. Synergistic efects. Te evaluation of the synergistic efects between the plant extract and the drug was determined in this study. For A.
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